P1074: PROGNOSIS ANALYSIS AND A NEW RISK MODEL FOR RELAPSED AND REFRACTORY HODGKIN LYMPHOMA PATIENTS TREATED BY ANTI-PD-1: A REAL-WORLD MULTICENTER RETROSPECTIVE STUDY OF PATIENTS IN CHINA
Authors: Wenyan Yu, Mei Geng, Jie Hao, Zeying Yan, Jian-Qing MI
Journal: HemaSphere (2023)

Topic: 17. Hodgkin lymphoma - Clinical Background: Although the promising benefit of PD-1 inhibitors for relapsed/refractory Hodgkin’s lymphoma (R/R HL) has been shown by several large clinical trials, there remains a paucity of studies describing outcomes and prognosis of patients with immunotherapy in a real-world setting. Meanwhile, there are still some patients not responded or early relapsed to new agents, thus raising the focus on prognostic factors in new era. Aims: We evaluated the real-world benefit and conducted a prognostic analysis of two PD-1 inhibitors developed in China (Sintilimab or Tislelizumab) for R/R HL patients, aiming to establish a new risk model for better immune risk-adapted therapeutic strategy. We hope our study could provide supplementary information to global related studies, as well as to be a reference for Asian working groups. Methods: We present a retrospective analysis of patients with R/R cHL who had failed ≥2 prior lines of therapies and received sintilimab or tislelizumab monotherapy at 3 medical centers from January 2020 to September 2022. Results: A total of 74 patients were reviewed. The median age was 38 years (range, 14-85 years). Patients had a median of 3 (2–6) previous lines of therapy. The ORR and CRR for the whole cohort were 78.3% and 52.7%, respectively. The median duration of follow-up was 22 (4–36) months. Overall, four patients (5.4%) died of disease progression during follow-up. The 2-y estimated PFS, DOR and OS rate was 43.3%, 45.1% and 94.1%, respectively. The median PFS and DOR was 22.1 and 23.5 months while the median OS has not reached. Ann Arbor IV (HR=3.547, p=0.044, 95% CI: 1.033–10.177) and refractoriness to most recent prior therapy (HR=4.002, p=0.031, 95% CI: 1.136–11.099) remained as independent prognostic factors for PFS based on multivariate analysis. Early response evaluation using either CT or PET/CT is predictive of long-term outcome in patients with R/R HL treated with anti-PD-1 mAbs. Significant differences were observed in PFS between patients who achieved the early C(M)R versus non-C(M)R (estimated 2y PFS: 71.9% vs. 32.3%, p=0.004). A new risk model incorporating traditional risk factors and early imaging assessment stratified patients into 3 classes: favorable group with early CR (n=21, 28.4%), unfavorable group or early non-CR (n=29, 39.2%), and unfavorable group with early non-CR (n=24, 32.4%), with 1-y PFS of 100.0%, 81.3%, and 37.5%, respectively (p=0.0001), as it was 75.0% vs. 43.3% vs. 15.0%, regarding estimated 2-y PFS (p< 0.0001) (Figure).Summary/Conclusion: Our findings suggest that PD-1 targeted immunotherapy with sintilimab or tislelizumab given in a real-world clinical setting was associated with efficacy similar to those reported by published trials. In new era of immunotherapy, several traditional risk factors retained certain impact on prognosis. Early imaging assessment appears to yield significantly prognostic value for R/R HL patients treated with anti-PD-1mAbs. The novel risk assessment model showed potential as a more powerful prognostic tool by identifying patients with significantly distinct outcomes, which warrants further validations and serves as a basis for future immune risk-adapted strategies. Keywords: Immunotherapy, Risk-adapted, Hodgkin’s lymphoma, relapsed/refractory